By NextBestFitPhase 4: Wave 4: everyone · Step 4.2
End employer-sponsored insurance for covered services
Year 4 · Employers; DOL; OPM (FEHB); state & local governmentsDiscuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | Job-based coverage for UHP services ends for about 179 million people. Employer premium payments of $1.05T (private, federal, state & local) stop; the employer tax ($873.4B) is at its full rate. Worker premium contributions ($382.1B) end. | ||
| Germany | High earners may opt out of statutory insurance into private insurance (PKV). | About 11% privately insured; faster specialist access for them. | Letting higher earners exit recreates the tier the plan ends. |
| Canada / UK | Employers offer only supplementary benefits (drugs, dental, private rooms, faster private access in the UK). | Employers still compete on benefits, but not on core coverage. | Employer benefits shrink to supplements; recruitment competition moves to wages. |
Germany
- What they did
- High earners may opt out of statutory insurance into private insurance (PKV).
- What happened
- About 11% privately insured; faster specialist access for them.
- Lesson for this plan
- Letting higher earners exit recreates the tier the plan ends.
Canada / UK
- What they did
- Employers offer only supplementary benefits (drugs, dental, private rooms, faster private access in the UK).
- What happened
- Employers still compete on benefits, but not on core coverage.
- Lesson for this plan
- Employer benefits shrink to supplements; recruitment competition moves to wages.
More precedent
- No wealthy country has made this exact transition from majority employer coverage. The closest is Taiwan, which merged labor and government employee insurance programs in 1995.